Apparatus for endotracheal and esophageal intubation

ABSTRACT

Apparatus for use in artificial respiration and the like, comprising an elongated tubular body having a flexible inner end portion adapted for insertion in the esophagus or trachea of a patient and an outer end portion for connection to a source of fluid. An inflatable cuff is carried at the inner end portion. The upper end portion of the tubular body includes an adaptor, a seal for the lumen of the tubular body carried by the adaptor and a plurality of closable openings spaced in the upper portion between the seal and the outer end of the tubular body. In the esophageal mode, the lumen of the tubular body is sealed to prevent the flow of fluids between the upper portion and lower portion of the tubular body. The openings in the upper portion are open to permit the flow of fluid therethrough into the patient&#39;&#39;s trachea and lungs. In the tracheal mode, the openings in the upper portion are closed, and the lumen of the tubular body is open to provide fluid communication through the tubular body.

United States Patent [191 Davidson Apr. 1, 1975 1 APPARATUS FORENDOTRACHEAL AND ESOPHAGEAL INTUBATION [76] Inventor: Kenneth L.Davidson, 12735 11th Ave., Victorville, Calif. 92392 [22] Filed: June 6,1974 [21] Appl. No.: 476,955

[52] US. Cl l28/l45.5, 128/351, l28/DIG. 9 [51] Int. Cl A61m 16/00 [58]Field of Search 128/1455, 145.6, 145.7,

128/1458, 351, 349 B, 349 BV, 350 R, 350 V, DIG. 9, 208, 209, 210

[56] References Cited UNITED STATES PATENTS 3,683,908 8/1972 Don Michael128/351 Primary E.\'aminerRichard A. Gaudet Assistant ExuminerHenry J.Recla Attorney, Agent, or Firm-Fulwider Patton Rieber Lee & Utecht [57]ABSTRACT Apparatus for use in artificial respiration and the like,comprising an elongated tubular body having a flexible inner end portionadapted for insertion in the esophagus or trachea of a patient and anouter end portion for connection to a source of fluid. An inflatablecuff is carried at the inner end portion. The upper end portion of thetubular body includes an adaptor, a seal for the lumen of the tubularbody carried by the adaptor and a plurality of closable openings spacedin the upper portion between the seal and the outer end of the tubularbody. In the: esophageal mode, the lumen of the tubular body is sealedto prevent the flow of fluids between the upper portion and lowerportion of the tubular body. The openings in the upper portion are opento permit the flow of fluid therethrough into the patients trachea andlungs. In the tracheal mode, the openings in the upper portion areclosed, and the lumen of the tubular body is open to provide fluidcommunication through the tubular body.

14 Claims, 7 Drawing Figures APPARATUS FOR ENDOTRACHEAL AND ESOPHAGEALINTUBATION BACKGROUND OF THE INVENTION This invention relates toapparatus for the introduction of fluids such as air, oxygen,anesthetics and the like into a patients lungs and more particularly toa tubular body adapted for both endotracheal and esophageal intubation.

It is often necessary or desirable in surgical procedures and the liketo control the patients breathing by intubation of the patients tracheafor the introduction of air, oxygen or anesthetic into the patientsrespiratory system. Intubation devices ordinarily include an elongatedflexible tubular body and an inflatable cuff is normally provided on aportion of the tube which is inserted in the patients trachea to providea seal between the tracheal lining and the walls of the tube. The end ofthe tube opposite the inserted end is adapted for connection to suitableapparatus for the introduction of air, oxygen, anesthetic or the like.Examples of such devices are disclosed in US. Pat. Nos. 3,460,541,Doherty and 3,599,642, Tindel. Such endotracheal devices, althoughsuccessful in maintaining an open airway for the patient can bedifficult to insert, particularly in case of an emergency, and normallyrequire the services of a highly skilled person for proper insertion ofthe device without injuring the patient.

A second type of intubation device has been used, particularly inemergency situations where prompt administration of artificialrespiration is critical. Such devices are elongated tubular bodies whichare designed to be inserted into the patients esophagus and which areprovided with a plurality of openings spaced on the upper portion of thetubular body for fluid communication with the patients respiratorypassage. The use of such a device ordinarily results in the inflation ofthe patients stomach which can result in the flow of stomach contentsback up through the tube. Such counterflow of stomach contents is bothunpleasant to a person administering artificial respiration and is alsodangerous to the patient since some of the stomach fluids may enter therespiratory passages and eventually the lungs of the patient. To avoidthis, apparatus designed for esophageal intubulation can be sealed atthe inner end to prevent inflation of the stomach with air, oxygen orthe like and to prevent the counterflow of stomach fluids up through thetube. An example of such a device is disclosed in US. Pat. No. 3,683,908Don Michael, et a1.

Generally speaking, and circumstances permitting, endotrachealintubation is preferred over esophageal intubation as being the mostefficient method for introduction of fluids into the patients lungs.However, where time does not permit, or where skilled personnel are notavailable, esophageal intubation is utilized since it is quicker andeasier to insert a tube into the patients esophagus without risk ofserious injury to the patient.

From the above discussion it can be seen that it is necessary for ahospital and/or emergency facilities such as fire departments and thelike, to stock both endotracheal and esophageal intubation tubes inorder to be prepared for the eventuality that one or the other procedurewill be required for the proper treatment of the patient. This undulymultiplies the number and type of intubation devices required to be onhand and adds to the expense of hospital and emergency facilityoperations. Also, in connection with esophageal intubation, inapproximately 20 percent of esophageal insertions the tube willaccidently enter the trachea resulting in a blockage of the patientsairway, if a conventionally sealed tube is being used.

SUMMARY OF THE INVENTION The present invention resides in apparatuswhich is readily adapted for use both in endotracheal and esophagealintubation procedures. In accordance with the present invention, theapparatus is quickly and easily modified to operate either as anesophageal intubation device or endotracheal intubation device dependingon whichever procedure is indicated under the circumstances.

More particularly, the apparatus of the present invention comprises anelongated tubular body having open ends and a throughrunning lumen. Thetubular body further defines a flexible, lower end portion for insertionin the patients esophagus or trachea and an upper end portion whichincludes an adapter for connection of the tubular body to a source offluid.

An inflatable cuff is positioned about the tubular body at the lowerportion thereof. As is standard practice, the cuff is inflated afterinsertion of the lower portion of the tubular body in the patientsesophagus or trachea to provide a seal with the walls of the esophagusor trachea.

The adapter is partially inserted in the flexible tube and the insertedend thereof is; modified for selectively sealing the lumen of thetubular body when the apparatus is in the esophageal intubation mode andthe opposite, extending end of the adapter defines the outer end of thetubular body for connection to a source of fluid. At least one opendischarge port is located at the outer end portion of the tubular bodyin spaced relation with the seal when the apparatus is in the esophagealmode.

In the endotracheal mode the seal is removed from the lumen and thedischarge port closed for direct fluid communication between the ends ofthe tubular body. During the insertion procedure, particularly into theesophagus, the apparatus is in the endotracheal mode with the lumenunsealed to provide an unrestricted airway in order to avoid the risk ofunintentionally blocking the patients airway.

Other objects and advantages of the present invention will becomeapparent from the following detailed description and taken inconjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 illustrates the apparatus ofthe present invention partially in solid line and partially in brokenline inserted in the esophagus of a patient as employed in esophagealintubation;

FIG. 2 is an enlarged side view, partially in section and partiallybroken away for compactness of illustration, of the apparatus of thepresent invention in the esophageal intubation mode;

FIG. 3 is a side elevation, partially broken away and partially insection, showing another embodiment of an adapter for use in theapparatus of the present invention for adapting the apparatus foresophageal intubation;

FIG. 4 is an enlarged sectional view taken through line 4-4 of FIG. 3;

FIG. 5 is a side sectional view of another adapter used in the apparatusof the present invention;

FIG. 6 is a top sectional view taken through line 6-6 of FIG. 5; and

FIG. 7 is a top sectional view taken through line 77 of FIG. 5.

DETAILED DESCRIPTION OF THE INVENTION As illustrated in the drawings,the invention is embodied in apparatus, indicated generally as 11, forendotracheal and esophageal intubation comprising a tube 12 having athroughrunning lumen and defining a flexible inner portion 13 adaptedfor insertion in the trachea or esophagus of a patient and an outerportion 14 adapted for connection to a source of air, oxygen, anestheticand the like. The outer portion 14 includes an adapter 16 which isinserted part way in the tube 12 and which extends beyond the end of thetube to define an open outer end 17 for connection to a source of fluid.The adapter 16 is modified for sealing the tube in the esophageal mode.At least one discharge opening 18 is located in the outer portion 14 ofthe tube 12 for fluid communication between the source of fluid and therespiratory tract of the patient when the apparatus is in the esophagealmode. When the lumen 15 of the tube 12 is open, the wall of the upperportion 14 is made continuous, such as by means carried on the upperportion of the tube for closing the opening 18 to provide fluidcommunication through 'the entire length of the lumen of the tube whenthe apparatus is in the endotracheal mode.

As illustrated in FIGS. 1 and 2, the apparatus of the present inventionis shown in the esophageal mode with the inner portion 13 of the tube 12inserted in the esophagus and with the outer end portion 14 extendingthrough the mouth and lips of the patient to a source of air, in thiscase an operator 19 applying artificial respiration.

As is more specifically shown in FIG. 2, the tube 12 is open-ended andflexible with the lumen 15 unrestricted along the length of the tube.The adapter 16 is inserted part way in one end of the tube 12 so that aportion of the adapter is contained in the lumen 15. The part of thetube containing the adapter and the adapter itself comprise the outerportion 14 and the remaining part of the tube comprises the flexibleinner portion 13 adapted to be inserted in the esophagus or the tracheaof the patient. The end of the lower portion is biased, as at 19, as anaid in inserting the tube.

A resilient cuff 21 surrounds the tube 12 adjacent the end of the innerportion 13. The cuff is bonded to the tube 12 at its edges 22 to providea chamber 23 between the inner surface of the cuff and the underlyingouter surface of the tube. A duct 12' extends along a side wall of thetube 12 between the outer portion 14 and the inner portion 13 of thetube and communicates at one end with the chamber 23 and at its oppositeend with a small air tube 24 and a bulb 26 provided with a removableplug 27 for holding the necessary pressure to maintain the cuff in aninflated condition and removable for inflating and deflating the cuff.

The adapter 16 is removably inserted in the tube 12 and includes acylindrical extending portion 28, the open outer end of which definesthe outer end 17 of the apparatus 11 for connection to a source offluid. A gripping ring 29 is provided on the exterior surface of thecylindrical portion 28 as an aid for inserting and removing the adapter.A face mask 31 may be integrally formed on the cylindrical portion 28 ofthe adapter or may be removably clamped thereon, such as by a clamp 32and screws 33.

The opposite end of the adapter carried within the tube is closed anddefines an enlarged bulbous plug 34 which is sized so as to provide afluid tight seal with the walls of the tube 12. Elongated slots 36 areprovided in the wall of the portion of the adapter 16 extending withinthe tube 12 for communication between the interior of the adapter 16 andthe lumen 15 of the tube. The portion of the adapter 16 carried withinthe tube 12 is preferably curved so, in combination with the tube, theouter portion 14 conforms to the anatomy of the patient.

The wall of the tube 12 at the outer portion 14 is provided with aplurality of apertures defining the discharge openings 18. The dischargeopenings 18 are in spaced relation with the outer end 17 of theapparatus 11 so as to be located between the outer end and the plug 34when the apparatus is in the esophageal mode. A sliding sleeve 37surrounds the tube 12 in the area of the discharge openings 18 and upperand lower containing rings 38 and 39 define the limits of travel for thesleeve so that in one position, the openings are closed by the sleeveand in another position the openings are unrestricted by the sleeve.

In operation the inner portion 13 of the tube 12 is inserted orally ornasally into the patients esophagus or trachea. During the insertionprocedure, the inflatable cuff 21 is deflated and the lumen 15 of thetube 12 is open so that at no time during the insertion procedure is thepatients airway blocked. When the tube 12 is inserted in the trachea,the sleeve 37 is moved downwardly against the lower retaining ring 39 toseal the discharge openings 18 in the wall of the tube so that the flowof fluid is through the lumen 15. A conventional, open ended,cylindrical adapter, not shown, is inserted in the end of the tube forconnection to a source of fluid. The inflatable cuff 21 is inflated toprovide a seal with the walls of the trachea to prevent the passage offluids between the external walls of the tube and the walls of thetrachea and to aid in retaining the tube in place.

When utilized in the esophageal mode, the insertion of the tube 12 is asdescribed above except that it is inserted in the esophagus rather thanthe trachea of the patient. Once inserted in the esophagus, the cuff 21is inflated and the sleeve 37 is moved up against the upper retainingring 38 so as to open the discharge openings 18. The adapter 16 isinserted in the upper end of the tube 12 so that the plug 34 is disposedbeyond the openings 18 and fluids are introduced to the patients lungsthrough the outer end 17, the outlet openings 18 and the trachea. Theface mask 31, is preferably fitted snugly around the nose and mouth areaof the patients face, to prevent the escape of fluid through thenostrils or mouth during the inhalation step.

It is highly preferred that the apparatus 11 be utilized in conjunctionwith the face mask 31 when utilizing the apparatus in the esophagealmode. When so used, it is not necessary that the discharge openings 18be disposed within the patients mouth and throat region and excellentresults are achieved when the discharge openings are located exteriorlyof the tube 12 rather than in the walls of the tube.

As is more specifically shown in FIG. 3, a different embodiment of theadapter 16 is shown. The adapter 16 comprises a cylindrical portion 42and a tapered portion 43 adapted to be inserted part way in the end ofthe tube 12. A plurality of slots 44 are provided around the peripheryof the adapter wall and normally open exteriorly of the tube 12 to theinterior of the face mask, not shown. A bottom wall 46 seals the bore ofthe adapter 41 and cooperates with the walls of the tube 12 surroundingthe tapered portion 43 of the adapter to seal the lumen of the tube.Excellent fluid communication between the discharge slots 44 and therespiratory passage of the patient is achieved and the danger that allor a portion of the discharge slots will be blocked, as might be thecase when the discharge openings are located in the patients mouth andthroat region, is avoided.

In the foregoing embodiments discussed in connection with FIGS. 2, 3 and4, it is necessary to insert the adapter 16 after insertion of the innerportion 13 into the esophagus so as to avoid sealing the lumen 15 priorto initiation of the esophageal intubation procedure. Also, whenutilizing the apparatus 11 of the present invention for endotrachealintubation, it is preferred practice to insert a conventional adapter inthe tube, although the tube may be used alone without an adapter. Inanother embodiment of the present invention the adapter 16 is modifiedfor use both as an adapter for endotracheal intubation and foresophageal intubation eliminating the necessity of exchanging adapters.

As is more specifically shown in FIGS. 5, 6 and 7, the adapter 16"comprises an outer sleeve 47 having a cylindrical portion 48 and atapered portion 49 adapted for part way insertion into the tube, notshown. A flange 51 is disposed adjacent the end of the outer sleeve 47carried within the tube and extends normally inwardly to block a portionof the bore of the sleeve 47 to define an eccentrically disposed opening52. A plurality of discharge slots 53 are disposed about the peripheryof the outer sleeve 47.

The outer sleeve 47 may be formed integrally with the tube as it is notnecessary that the adapter 16 be removable in this embodiment of theinvention.

An inner sleeve 54, conforming substantially to the dimensions of thebore of the outer sleeve, is rotatably positioned within the outersleeve and the bore of the inner sleeve defines the bore of the adapter16'. An 0- ring or other suitable sealing means, not shown, may bedisposed between the inner sleeve 54 and the bore of the outer sleeve 47to provide a fluid tight seal therebetween. One end of the inner sleeve54 terminates adjacent the flange 51 of the outer sleeve 47 and aportion 57 of the wall of the inner sleeve is inwardly biased to form amember blocking a portion of the bore of the inner sleeve and to definea restricted, eccentrically disposed opening 58 at the end of the innersleeve adjacent the flange 51 of the outer sleeve 47. A bottom surface60 is defined by the inwardly biased wall portion 57 and the bottomsurface is contiguous with the upper surface of the flange 51 in oneposition and is disposed across the opening 52 when the inner sleeve 54is rotated. The opposite end 58 of the inner sleeve 54 extends beyondthe outer sleeve 47 to provide a gripping surface for rotating the innersleeve and a point of connection of the adapter to a source of fluid.

A plurality of openings 59 are provided in the periphery of the innersleeve 54. The openings 59 are longitudinally aligned with the dischargeslots 53 and radially positioned for alignment to providefluidcommunication through the discharge slots 53 and for misalignment toclose the discharge slots 53 when the inner sleeve 54 is rotated.

The inner sleeve 54 is restrained from longitudinal movement within theouter sleeve 47 by a retainer ring 61 formed on the outer surface of theinner sleeve which is snap fitted into an annular recess 62 formed inthe wall of the outer sleeve. Rotation of the inner sleeve 54 is limitedby an inwardly extending pin 63 carried on the inner wall of the outersleeve 47 which is received in a peripheral guide slot 64 formed on theouter Wall surface of the inner sleeve so that rotation of the innersleeve is permitted only between a first position and a second position.

As illustrated in FIGS. 5, 6 and 7, the adapter 16" is the endotrachealmode with the openings 52 and S8 aligned so that the bore of the adapter16 is unsealed and the discharge slots 53 and openings 59 misaligned andthereby closed. By rotating the inner sleeve 54 until the pin 63contacts the opposite edge of the slot 64, the adapter 16" is placed inthe esophageal mode with the openings 52 and 58 misaligned and thebottom surface of the inwardly sloped wall portion 57 of the innersleeve 54 cooperating with the flange 51 of the outer sleeve 47 to sealthe bore of the adapter 16. The discharge slots 53 of the outer sleeve47 and the openings 56 of the inner sleeve 54 are radially aligned so asto permit fluid communication from the bore of the adapter to therespiratory passages of the patient in the manner previously described.Although not shown, a face mask is carried by the extending portion ofthe outer sleeve.

From the foregoing, it can be seen that the apparatus of the presentinvention is readily adapted to operate in endotracheal and esophagealintubation, depending on the circumstances of the patient and the skilland choice of the person performing the intubation. During the insertionprocedure, the patients airway is never closed, thereby avoiding therisk of asphyxiation during the insertion procedure, particularly wherethe operator is not highly skilled. When used in the esophageal mode,the reverse flow of fluids through the lumen of the tube is prevented bythe seal carried by the adapter and the danger of aspiration of stomachfluids into the lungs is avoided. Prior to removal of the tube, stomachcontents can be readily removed by insertion of a suction catheterthrough the tubular body into the stomach. The same apparatus is readilyused for endotracheal intubation thereby eliminating the necessity ofstocking more than one type of intubation apparatus.

The materials of construction of the apparatus of the present inventionare those conventionally used for conventional esophageal andendotracheal intubators. The apparatus of the present invention can beconstructed so as to be sterilizable and reusable or can be constructedso as to be disposable after a single use.

I claim:

1. Apparatus for endotracheal and esophageal intubation, said apparatuscomprising:

an elongated tubular body having an open outer and open inner end, saidtubular body defining an upper portion and a flexible lower portion anda lumen extending between said outer and inner ends;

means in said upper portion for selectively sealing said lumen; and

means for selectively providing fluid communication between said outerend and the exterior of said upper portion, said means being spacedbetween said outer end and said sealing means;

means carried about said lower portion of said tubular body forinsertion within a body canal to form a seal with the walls thereof;

whereby said apparatus is adapted for endotracheal intubation when saidlumen is open for fluid communication between said outer end and saidinner end and said apparatus is adapted for esophageal intubation whensaid lumen is sealed and adapted for fluid communication between saidouter end and the exterior of said upper portion.

2. The apparatus as defined in claim 1 wherein said means carried aboutsaid lower portion of said tubular body comprises an inflatable memberin spaced relation with said lower end for inflation within a body canalto form a seal with the walls thereof.

3. The apparatus as defined in claim 1 wherein said tubular bodycomprises:

a flexible, open-ended tube; and

a tubular adapter, a portion thereof being received in one end of saidtube, said adapter and tube portion receiving said adapter defining saidupper portion of said tubular body and the remaining portion of saidtube defining said flexible lower portion of said tubular body.

4. The apparatus as defined in claim 3 wherein said adapter is removablyreceived in said flexible tube, one end of said adapter and a portionthereof adjacent to said end extending longitudinally outwardly fromsaid flexible tube, said one end being open to define said outer end ofsaid tubular body, the opposite end portion of said adapter beingreceived in said lumen of said flexible tube and adapted to define afluid tight seal with the inner walls of said tube.

5. The apparatus as defined in claim 4 further includa plurality ofdischarge openings in the walls of said tube portion receiving saidadapter, said openings being in spaced relation with said end portion ofsaid adapter forming said sealing means;

the wall of said portion of said adapter received in said lumen of saidtube being provided with at least one opening for fluid communicationbetween said open outer end and said discharge openings; and

means carried by said tube for selectively closing said dischargeopenings.

6. The apparatus as defined in claim 5 wherein said means forselectively closing said discharge openings comprises a sleeve slidablycarried on said upper portion for movement between a withdrawn positionwherein said discharge openings are unrestricted and a second positionoverlying said discharge openings thereby to close them.

7. The apparatus as defined in claim 4 wherein said discharge openingsare located in said end portion of said adapter extending outwardly fromsaid tube and the walls of said tube are continuous.

8. The apparatus as defined in claim 5 wherein said end portion of saidadapter received in said tube is radially inwardly tapered and the endthereof defines an enlarged plug forming a fluid seal with the walls ofsaid tube, and at least one elongated slot being provided in a wall ofsaid tapered end portion for unrestricted fluid communication betweenthe interior of said adapter and said peripheral openings of said upperportion of said tubular body.

9. The apparatus as defined in claim 3 wherein said adapter comprises:

a first sleeve having an inner and outer end, the inner end thereofcommunicating with said lumen of said tube and being provided with aflange extending across a portion of the opening between said firstsleeve and said lumen of said tube;

a plurality of peripheral slots extending between the inner and outersurfaces of said first sleeves and being in longitudinally spacedrelation with said flange;

a second sleeve having an outside diameter substantially equal to theinside diameter of said first sleeve rotatably carried within said firstsleeve for rotation between a first and a second position, said secondsleeve having an end co-terminus with said inner end of said firstsleeve;

said second sleeve interior defining the bore of said adapter, aninterior wall portion adjacent said coterminus end being biased inwardlywith respect to the longitudinal axis of said second sleeve in adirection toward said co-terminus end, said inwardly biased wall portioncooperating with said flange of said first sleeve to seal said lumen ofsaid tube when said second sleeve is rotated into said first positionand to open said lumen when rotated into said second position;

plurality of peripheral slots in said second sleeve being longitudinallyaligned with said slots of said first sleeve and being radially alignedtherewith when said second sleeve is in said first position, thereby toprovide fluid communication from the interior of said adapter to theexterior thereof, and being radially misaligned when said second sleeveis in said second position thereby to seal said slots of said firstsleeve.

10. The apparatus as defined in claim 9 wherein said first sleeve isintegral with said tube.

11. Apparatus for esophageal intubation comprising:

a flexible elongated tube adapted for insertion in the esophagus andhaving an outer end and an inner end;

an inflatable member carried on said tube adjacent said inner end;

means for inflating said member communicating therewith;

an adapter having an open end, a closed end and a bore extendingtherebetween being removably inserted in said outer end of said tube sothat said closed end and a portion of said adapter adjacent said closedend are disposed within said tube;

said closed end of said adapter defining a seal for said tube to preventfluid flow between said outer and inner ends of said tube;

a plurality of openings in said tube wall, said openings being spacedbetween said outer end of said tube and said closed end of said adapter;

a port in the wall of said portion of said adapter disposed within saidtube communicating the bore of said adapter with said openings in saidtube wall.

12. The apparatus of claim 11 further including a sleeve slidablycarried on said tube and movable between position on said tube overlyingand closing said openings and a position on said tube wherein saidopenings are unobstructed.

13. Apparatus for esophageal intubation comprising:

a flexible elongated tube adapted for insertion in the esophagus andhaving an outer end and an inner end;

an inflatable member carried on said tube adjacent said inner end;

means for inflating said member communicating therewith;

an adapter having an open end, a closed end and a bore extendingtherebetween being removably inserted in said outer end of said tube sothat said closed end and a portion of said adapter adjacent said closedend are disposed in said tube and the remaining portion of said adapterextends beyond said outer end of said tube;

a mask for covering the nose and mouth of a patient carried by saidadapter portion extending beyond said tube; and plurality of openingsdisposed about the periphery of said adapter portion extending beyondsaid tube, said openings being in spaced relation within said mask forfluid communication between the bore of said adapter and the patientsrespiratory tract. 14. Apparatus for esophageal intubation comprising: aflexible elongated tube adapted for insertion in the esophagus andhaving an outer end and an inner end;

an inflatable member carried on said tube adjacent said inner end;

means for inflating said member communicating therewith;

an adapter having an open end, a sealable inner end and a bore extendingtherebetween being connected at said inner end to said outer end of saidtube, at least a portion of said adapter extending beyond said outer endof said tube, a mask for covering the nose and mouth. of a patientcarried by said extending portion;

said adapter further including a first sleeve defining a bore and aninner end, a flange adjacent said inner end extending normal to saidbore and blocking a portion thereof to define a restricted,eccentrically disposed opening between said bore and said lumen of saidtube, and a plurality of radially spaced openings disposed about theperiphery of said first sleeve in spaced relation between said mask andsaid outer end of said tube;

a second sleeve co-axially mounted in said first sleeve for rotationbetween a first position and a second portion, said second sleeve havinga bore, one end substantially co-terminus with said flange of said firstsleeve and an interior wall portion adjacent said co-terminus end biasedinwardly with respect to the longitudinal axis of said second sleeve ina direction toward said co-terminus end to define an eccentricallydisposed opening at said co-terminus end of said second sleeve, aplurality of openings disposed about the periphery of said second sleevein longitudinal alignment with said openings of said first sleeve andspaced for radial alignment therewith when said second sleeve is in saidfirst position and for misalignment when said inner sleeve is in saidsecond position, whereby in said first position said eccentricallydisposed openings at the ends of said first and second sleeves aremisaligned, said flange of said first sleeve and said wall portion ofsaid second sleeve cooperating to close said inner end of said adapterand said openings of first and second sleeves are aligned, and in saidsecond position said eccentrically disposed openings are aligned forfluid communication with said tube and said peripheral openings of saidfirst and second sleeves are misaligned.

TJNTTTD STATES PATENT oTTtoE QERHMQATE m t'iEfiTwN PATENT NO. 13,874,377

INVENTOR(S) :Kenneth L. Davidson It is certified that error appears inthe above-identified patent and that said Letters Patent are herebycorrected as shown below:

In Column 10, Line 15, please delete the nineteenth fiy Qf Augusrl975i'gncd an r SEAL] Arrest:

RUTH C. MASON C. MARSHALL DANN Arresting Office (ummissiuner uj'larenrsand TVHrJtHIUT/U

1. Apparatus for endotracheal and esophageal intubation, said apparatuscomprising: an elongated tubular body having an open outer and openinner end, said tubular body defining an upper portion and a flexiblelower portion and a lumen extending between said outer and inner ends;means in said upper portion for selectively sealing said lumen; andmeans for selectively providing fluid communication between said outerend and the exterior of said upper portion, said means being spacedbetween said outer end and said sealing means; means carried about saidlower portion of said tubular body for insertion within a body canal toform a seal with the walls thereof; whereby said apparatus is adaptedfor endotracheal intubation when said lumen is open for fluidcommunication between said outer end and said inner end and saidapparatus is adapted for esophageal intubation when said lumen is sealedand adapted for fluid communication between said outer end and theexterior of said upper portion.
 2. The apparatus as defined in claim 1wherein said means carried about said lower portion of said tubular bodycomprises an inflatable member in spaced relation with said lower endfor inflation within a body canal to form a seal with the walls thereof.3. The apparatus as defined in claim 1 wherein said tubular bodycomprises: a flexible, open-ended tube; and a tubular adapter, a portionthereof being received in one end of said tube, said adapter and tubeportion receiving said adapter defining said upper portion of saidtubular body and the remaining portion of said tube defining saidflexible lower portion of said tubular body.
 4. The apparatus as definedin claim 3 wherein said adapter is removably received in said flexibletube, one end of said adapter and a portion thereof adjacent to said endextending longitudinally outwardly from said flexible tube, said one endbeing open to define said outer end of said tubular body, the oppositeend portion of said adapter being received in said lumen of saidflexible tube and adapted to define a fluid tight seal with the innerwalls of said tube.
 5. The apparatus as defined in claim 4 furtherincluding: a plurality of discharge openings in the walls of said tubeportion receiving said adapter, said openings being in spaced relationwith said end portion of said adapter formIng said sealing means; thewall of said portion of said adapter received in said lumen of said tubebeing provided with at least one opening for fluid communication betweensaid open outer end and said discharge openings; and means carried bysaid tube for selectively closing said discharge openings.
 6. Theapparatus as defined in claim 5 wherein said means for selectivelyclosing said discharge openings comprises a sleeve slidably carried onsaid upper portion for movement between a withdrawn position whereinsaid discharge openings are unrestricted and a second position overlyingsaid discharge openings thereby to close them.
 7. The apparatus asdefined in claim 4 wherein said discharge openings are located in saidend portion of said adapter extending outwardly from said tube and thewalls of said tube are continuous.
 8. The apparatus as defined in claim5 wherein said end portion of said adapter received in said tube isradially inwardly tapered and the end thereof defines an enlarged plugforming a fluid seal with the walls of said tube, and at least oneelongated slot being provided in a wall of said tapered end portion forunrestricted fluid communication between the interior of said adapterand said peripheral openings of said upper portion of said tubular body.9. The apparatus as defined in claim 3 wherein said adapter comprises: afirst sleeve having an inner and outer end, the inner end thereofcommunicating with said lumen of said tube and being provided with aflange extending across a portion of the opening between said firstsleeve and said lumen of said tube; a plurality of peripheral slotsextending between the inner and outer surfaces of said first sleeves andbeing in longitudinally spaced relation with said flange; a secondsleeve having an outside diameter substantially equal to the insidediameter of said first sleeve rotatably carried within said first sleevefor rotation between a first and a second position, said second sleevehaving an end co-terminus with said inner end of said first sleeve; saidsecond sleeve interior defining the bore of said adapter, an interiorwall portion adjacent said co-terminus end being biased inwardly withrespect to the longitudinal axis of said second sleeve in a directiontoward said co-terminus end, said inwardly biased wall portioncooperating with said flange of said first sleeve to seal said lumen ofsaid tube when said second sleeve is rotated into said first positionand to open said lumen when rotated into said second position; aplurality of peripheral slots in said second sleeve being longitudinallyaligned with said slots of said first sleeve and being radially alignedtherewith when said second sleeve is in said first position, thereby toprovide fluid communication from the interior of said adapter to theexterior thereof, and being radially misaligned when said second sleeveis in said second position thereby to seal said slots of said firstsleeve.
 10. The apparatus as defined in claim 9 wherein said firstsleeve is integral with said tube.
 11. Apparatus for esophagealintubation comprising: a flexible elongated tube adapted for insertionin the esophagus and having an outer end and an inner end; an inflatablemember carried on said tube adjacent said inner end; means for inflatingsaid member communicating therewith; an adapter having an open end, aclosed end and a bore extending therebetween being removably inserted insaid outer end of said tube so that said closed end and a portion ofsaid adapter adjacent said closed end are disposed within said tube;said closed end of said adapter defining a seal for said tube to preventfluid flow between said outer and inner ends of said tube; a pluralityof openings in said tube wall, said openings being spaced between saidouter end of said tube and said closed end of said adapter; a port inthe wall of said portion of said adapter disposed within said tubecommunIcating the bore of said adapter with said openings in said tubewall.
 12. The apparatus of claim 11 further including a sleeve slidablycarried on said tube and movable between position on said tube overlyingand closing said openings and a position on said tube wherein saidopenings are unobstructed.
 13. Apparatus for esophageal intubationcomprising: a flexible elongated tube adapted for insertion in theesophagus and having an outer end and an inner end; an inflatable membercarried on said tube adjacent said inner end; means for inflating saidmember communicating therewith; an adapter having an open end, a closedend and a bore extending therebetween being removably inserted in saidouter end of said tube so that said closed end and a portion of saidadapter adjacent said closed end are disposed in said tube and theremaining portion of said adapter extends beyond said outer end of saidtube; a mask for covering the nose and mouth of a patient carried bysaid adapter portion extending beyond said tube; and a plurality ofopenings disposed about the periphery of said adapter portion extendingbeyond said tube, said openings being in spaced relation within saidmask for fluid communication between the bore of said adapter and thepatient''s respiratory tract.
 14. Apparatus for esophageal intubationcomprising: a flexible elongated tube adapted for insertion in theesophagus and having an outer end and an inner end; an inflatable membercarried on said tube adjacent said inner end; means for inflating saidmember communicating therewith; an adapter having an open end, asealable inner end and a bore extending therebetween being connected atsaid inner end to said outer end of said tube, at least a portion ofsaid adapter extending beyond said outer end of said tube, a mask forcovering the nose and mouth of a patient carried by said extendingportion; said adapter further including a first sleeve defining a boreand an inner end, a flange adjacent said inner end extending normal tosaid bore and blocking a portion thereof to define a restricted,eccentrically disposed opening between said bore and said lumen of saidtube, and a plurality of radially spaced openings disposed about theperiphery of said first sleeve in spaced relation between said mask andsaid outer end of said tube; a second sleeve co-axially mounted in saidfirst sleeve for rotation between a first position and a second portion,said second sleeve having a bore, one end substantially co-terminus withsaid flange of said first sleeve and an interior wall portion adjacentsaid co-terminus end biased inwardly with respect to the longitudinalaxis of said second sleeve in a direction toward said co-terminus end todefine an eccentrically disposed opening at said co-terminus end of saidsecond sleeve, a plurality of openings disposed about the periphery ofsaid second sleeve in longitudinal alignment with said openings of saidfirst sleeve and spaced for radial alignment therewith when said secondsleeve is in said first position and for misalignment when said innersleeve is in said second position, whereby in said first position saideccentrically disposed openings at the ends of said first and secondsleeves are misaligned, said flange of said first sleeve and said wallportion of said second sleeve cooperating to close said inner end ofsaid adapter and said openings of first and second sleeves are aligned,and in said second position said eccentrically disposed openings arealigned for fluid communication with said tube and said peripheralopenings of said first and second sleeves are misaligned.